Podcast
Questions and Answers
What is the required action regarding the medical history before treating a patient?
What is the required action regarding the medical history before treating a patient?
- It can be updated only after the treatment is finished.
- It should only be documented once at the first visit.
- It should be ignored if it seems irrelevant.
- It must be completed and/or reviewed at the start of treatment. (correct)
Which ASA classification is appropriate for a patient requiring treatment in a hospital setting?
Which ASA classification is appropriate for a patient requiring treatment in a hospital setting?
- ASA I
- ASA IV (correct)
- ASA III
- ASA II
What blood pressure reading is defined as hypertension?
What blood pressure reading is defined as hypertension?
- Equal to or greater than 130/80 (correct)
- Between 120/80 and 129/89
- Lower than 120/80
- Only when experiencing symptoms
How often should a patient's medical history be updated?
How often should a patient's medical history be updated?
What percentage of the population approximately suffers from hypertension?
What percentage of the population approximately suffers from hypertension?
What defines a hypertensive emergency?
What defines a hypertensive emergency?
Which of the following is considered a major risk factor for cardiovascular disease?
Which of the following is considered a major risk factor for cardiovascular disease?
Which intervention should be considered to mitigate hypertensive urgencies in patients?
Which intervention should be considered to mitigate hypertensive urgencies in patients?
Which statement about antihypertensives is true?
Which statement about antihypertensives is true?
What is a characteristic of hypertensive urgency?
What is a characteristic of hypertensive urgency?
Which of the following is a minor risk factor for cardiovascular complications?
Which of the following is a minor risk factor for cardiovascular complications?
What should be monitored during procedures on hypertensive patients?
What should be monitored during procedures on hypertensive patients?
Which treatment should be avoided in patients with severe hypertension?
Which treatment should be avoided in patients with severe hypertension?
What is the classic cause of infective endocarditis characterized by infection of the heart valves?
What is the classic cause of infective endocarditis characterized by infection of the heart valves?
Which of the following best describes the Duke Activity Status Index (DASI)?
Which of the following best describes the Duke Activity Status Index (DASI)?
Which is a risk associated with untreated heart failure?
Which is a risk associated with untreated heart failure?
What is one of the peripheral manifestations of infective endocarditis?
What is one of the peripheral manifestations of infective endocarditis?
Which situation necessitates antibiotic prophylaxis for patients regarding infective endocarditis?
Which situation necessitates antibiotic prophylaxis for patients regarding infective endocarditis?
What does a score in the Duke Activity Status Index indicate?
What does a score in the Duke Activity Status Index indicate?
What is the mortality rate for infective endocarditis in the US?
What is the mortality rate for infective endocarditis in the US?
Which of the following is a causative microorganism for infective endocarditis?
Which of the following is a causative microorganism for infective endocarditis?
Which valve condition classifies as native valve endocarditis?
Which valve condition classifies as native valve endocarditis?
Which of the following patients is at an increased risk for infective endocarditis?
Which of the following patients is at an increased risk for infective endocarditis?
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Study Notes
Nitroglycerin (GTN) Administration
- Dosage: 0.3 to 0.4 mg sublingually (SL) or as a spray, up to two doses at 3 to 5-minute intervals.
- Contraindications include low systolic blood pressure (SBP) and orthostatic hypotension awareness.
- Use caution with antiplatelets or anticoagulants; patients may also be on Digoxin.
- Avoid benzodiazepines due to possible increased Digoxin serum levels.
- Excessive vasoconstrictor use may trigger arrhythmias.
- Untreated symptomatic heart failure raises risks of myocardial infarction (MI), arrhythmias, acute heart failure, or sudden death.
Duke Activity Status Index (DASI)
- A 12-item survey to assess self-reported physical work capacity estimating peak metabolic equivalents (METs).
- Higher scores indicate better functional capacity compared to NYHA classification.
- 1 MET equates to 1 kcal/kg/hr or 3.5 ml/kg/min oxygen consumption at rest.
Infective Endocarditis
- Caused by microbial infections of heart endothelial surfaces or valves, with a US mortality rate of 40%.
- Classifications include:
- By microorganism: Streptococcal, Staphylococcal, Candida.
- By valve type: Native valve endocarditis (NVE) or prosthetic valve endocarditis (PVE).
- By infection source: Community-acquired, hospital-acquired, intravenous drug use (IVDU).
- Prevention is emphasized due to treatment difficulties.
Signs and Symptoms of Infective Endocarditis
- Common symptoms include fever, heart murmur, and positive blood cultures.
- Rare peripheral manifestations:
- Osler’s nodes (subcutaneous nodules)
- Janeway lesions (petechiae)
- Splinter hemorrhages (nail bed)
- Roth spots (retinal hemorrhages)
- Splenomegaly and digital clubbing.
American Heart Association (AHA) Guidelines
- Considerations for prophylactic antibiotics include:
- Presence of prosthetic heart valves or materials for valve repair.
- History of infective endocarditis.
- Specific congenital heart diseases and those repaired within 6 months involving prosthetic material.
Hypertensive Conditions
- Hypertensive Urgency: Blood pressure ≥180/≥110 mmHg with minimal or no symptoms.
- Hypertensive Emergency: Severe blood pressure elevation with signs of target organ dysfunction, such as encephalopathy or acute MI.
- Recommendations include identifying hypertension, medication management, and intraoperative monitoring.
- Antihypertensive medications: diuretics, beta blockers, ACE inhibitors, ARBs, CCBs; monitor for orthostatic hypotension and avoid prolonged NSAID use.
Cardiovascular Risk Factors
- Major risks: unstable coronary syndromes, decompensated heart failure, severe arrhythmias, and significant valvular disease.
- Intermediate risks: history of ischemic heart disease (IHD), compensated heart failure, cerebrovascular issues, diabetes, renal insufficiency.
- Minor risks: age >70, abnormal ECGs, and uncontrolled systemic hypertension.
Medical History Considerations
- Essential for assessing systemic diseases before treatments and procedures.
- Ensure thorough medical history review at the start of treatment and maintain regular updates.
Hypertension Overview
- Defined by sustained pressures ≥130/80 mmHg; affects approximately 1 in 4 people.
- Many individuals remain asymptomatic initially but may eventually develop organ damage to the kidneys, heart, brain, and eyes.
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